Talking allergy testing and dermatology with Julia Miller

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Julia Miller, DVM, DACVD:

Allergy testing is something I love to do for my environmentally allergic pets. So I go through the whole process of ruling out flea allergy, making sure it's not a food allergy. And then when we get into environmental allergies being the cause for the patient's itch, that's what I'll often recommend allergy testing. But I don't do allergy testing just to know what they're allergic to because you can't avoid. I always tell people, if you figure out how to avoid ragweed, you tell no one else, you tell me, and then we'll be rich together. So, we don't do it for avoidance purposes or just no. knowledge. What we do allergy testing for is for to create immunotherapy so that we can then create the own specific allergy vaccine or injection for that particular patient to try to desensitize them. It can be really hard to tell the difference so the only way to truly know if you've got a pet that is not non -seasonally itchy, so how they present the same, food allergies and environmental allergies can both be non -seasonally itchy, that's the big thing that we see. They can have recurrent ear infections for both of them, recurrent anal saculitis, things like that. So if you have that non -seasonally itchy kiddo that gets recurrent ear infections, then you're kind of in the well is it food or is it environment, and what you have to do, fortunately, unfortunately, what you have to do first is rule out food. That's the critical thing. So a strict prescription diet trial is the way to rule out a food allergy. And then once you rule out that food allergy, then you proceed with environmental stuff. So there's a lot of tools in our toolbox. And I think it is really important that we utilize them. So you know, Apoquel is great, Cytopoint is great, but we need some epidermal barrier support in these dogs. We need to reduce surface microbes. Some patients actually really benefit from routine bathing, things like that. So the more you utilize the different tools in your toolbox and approach from an inside out and outside in kind of a way, you can actually create a much happier, healthier patient that may be less reliant on drugs and you tend to see your itch control be better.

So for topicals, I think there are so many out there that are fantastic. The number one rule I go by is what will the client do? So I'm always looking for a topical that smells nice, goes on nice, and is easy for the client to use because if they can't do it, they're not going to do it and then it doesn't help us out at all. So I always have a conversation with the client and try to see what will be the easiest for them to use.

Yeah, I think dermatology is a tricky one, right? Because when it comes to like doing knee surgery, for example, a lot of vets are ready to refer to a surgeon for that because the truth is, if you mess that up, that's a big deal, right? That dog will never walk normally, that's a big, big deal. With dermatology, I find a lot of people take because the dog is probably not going to die or limp, it's just going to be really itchy, right? But what people forget is that itchy dogs have a tough life, right? And the client-animal bond gets ruined a lot by these itchy dogs. So I think with dermatology, a lot of people don't refer because there are a lot of things you can do as a general practitioner and safely can do as a general practitioner, but that doesn't mean that referral doesn't have a really strong place because we can just help you be better. better. That's the way I look at dermatology referral, is I can just help you be better, create a happier patient, and then I'll ship them back to you for that TPLO.

Yeah, sometimes finances or distance, you know, that it just isn't always an option. I know, for example, I take phone calls all the time from local veterinarians and I talk through a case. I think there's a couple of things you can do there. One is. call around. You may not know that there's a specialist in your area who loves to talk to general practitioners. When I was a GP in North Carolina, I didn't know but there was an ophthalmologist around the corner who was phenomenal. I called her all the time and she really helped me out quite a bit. So I think find out who's in your area, find out if they take phone consultations. Another big thing you can do to help with that is take good pictures of your lesions. So if you call me and you say, "Hey Dr. J, I've got this case." You explain it, you're explaining it. the lesions. I'll often say to you hey do you have a picture because you know pictures are worth a thousand words in dermatology so take some good pictures reach out to the specialists in your area and you'll often find they'll be able to collaborate with you on cases.

There's so many good things out there I think more and more there's a lot of social media presence that's really geared towards clients. DVM 360 has some stuff that's excellent for that. DECRA, a lot of the big companies that have products also have excellent websites. Greer or Allergens, Stallergens Greer has actually an online page. It's all about pet allergies and that's really a nice one. So I think there are some very good company-based websites out there that are excellent.

Yeah, I think there's a lot. So Clinician's Brief, for example, has a number of different handouts that I've seen. I've also seen VIN have a number of great handouts. So the derm handouts are floating out there. You don't necessarily have to reinvent the wheel. You might be able to find a handout that suits your needs. But if you can't, spend 20 minutes, create the handout you want, and then you can kind of print that off for your clients, too.